-
The Cochrane Database of Systematic... Apr 2013Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with the prolapse. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with the prolapse.
OBJECTIVES
To determine the effects of the many different surgeries used in the management of pelvic organ prolapse.
SEARCH METHODS
We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In Process and handsearching of journals and conference proceedings, healthcare-related bibliographic databases, handsearched conference proceedings (searched 20 August 2012), and reference lists of relevant articles. We also contacted researchers in the field.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse.
DATA COLLECTION AND ANALYSIS
Trials were assessed and data extracted independently by two review authors. Six investigators were contacted for additional information with five responding.
MAIN RESULTS
Fifty-six randomised controlled trials were identified evaluating 5954 women. For upper vaginal prolapse (uterine or vault) abdominal sacral colpopexy was associated with a lower rate of recurrent vault prolapse on examination and painful intercourse than with vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. In single studies the sacral colpopexy had a higher success rate on examination and lower reoperation rate than high vaginal uterosacral suspension and transvaginal polypropylene mesh.Twenty-one trials compared a variety of surgical procedures for anterior compartment prolapse (cystocele). Ten compared native tissue repair with graft (absorbable and permanent mesh, biological grafts) repair for anterior compartment prolapse. Native tissue anterior repair was associated with more recurrent anterior compartment prolapse than when supplemented with a polyglactin (absorbable) mesh inlay (RR 1.39, 95% CI 1.02 to 1.90) or porcine dermis mesh inlay (RR 2.08, 95% CI 1.08 to 4.01), however there was no difference in post-operative awareness of prolapse after absorbable mesh (RR 0.96, 95% CI 0.33 to 2.81) or a biological graft (RR 1.21, 95% CI 0.64 to 2.30). Data on morbidity and other clinical outcomes were lacking. Standard anterior repair was associated with more anterior compartment prolapse on examination than for any polypropylene (permanent) mesh repair (RR 3.15, 95% CI 2.50 to 3.96). Awareness of prolapse was also higher after the anterior repair as compared to polypropylene mesh repair (28% versus 18%, RR 1.57, 95% CI 1.18 to 2.07). However, the reoperation rate for prolapse was similar at 14/459 (3%) after the native tissue repair compared to 6/470 (1.3%) (RR 2.18, 95% CI 0.93 to 5.10) after the anterior polypropylene mesh repair and no differences in quality of life data or de novo dyspareunia were identified. Blood loss (MD 64 ml, 95% CI 48 to 81), operating time (MD 19 min, 95% CI 16 to 21), recurrences in apical or posterior compartment (RR 1.9, 95% CI 1.0 to 3.4) and de novo stress urinary incontinence (RR 1.8, 95% CI 1.0 to 3.1) were significantly higher with transobturator meshes than for native tissue anterior repair. Mesh erosions were reported in 11.4% (64/563), with surgical interventions being performed in 6.8% (32/470).Data from three trials compared native tissue repairs with a variety of total, anterior, or posterior polypropylene kit meshes for vaginal prolapse in multiple compartments. While no difference in awareness of prolapse was able to be identified between the groups (RR 1.3, 95% CI 0.6 to 1.7) the recurrence rate on examination was higher in the native tissue repair group compared to the transvaginal polypropylene mesh group (RR 2.0, 95% CI 1.3 to 3.1). The mesh erosion rate was 35/194 (18%), and 18/194 (9%) underwent surgical correction for mesh erosion. The reoperation rate after transvaginal polypropylene mesh repair of 22/194 (11%) was higher than after the native tissue repair (7/189, 3.7%) (RR 3.1, 95% CI 1.3 to 7.3).Data from three trials compared posterior vaginal repair and transanal repair for the treatment of posterior compartment prolapse (rectocele). The posterior vaginal repair had fewer recurrent prolapse symptoms (RR 0.4, 95% CI 0.2 to 1.0) and lower recurrence on examination (RR 0.2, 95% CI 0.1 to 0.6) and on defecography (MD -1.2 cm, 95% CI -2.0 to -0.3).Sixteen trials included significant data on bladder outcomes following a variety of prolapse surgeries. Women undergoing prolapse surgery may have benefited from having continence surgery performed concomitantly, especially if they had stress urinary incontinence (RR 7.4, 95% CI 4.0 to 14) or if they were continent and had occult stress urinary incontinence demonstrated pre-operatively (RR 3.5, 95% CI 1.9 to 6.6). Following prolapse surgery, 12% of women developed de novo symptoms of bladder overactivity and 9% de novo voiding dysfunction.
AUTHORS' CONCLUSIONS
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinous colpopexy, uterosacral colpopexy and transvaginal mesh. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living, and increased cost of the abdominal approach.The use of mesh or graft inlays at the time of anterior vaginal wall repair reduces the risk of recurrent anterior wall prolapse on examination. Anterior vaginal polypropylene mesh also reduces awareness of prolapse, however these benefits must be weighted against increased operating time, blood loss, rate of apical or posterior compartment prolapse, de novo stress urinary incontinence, and reoperation rate for mesh exposures associated with the use of polypropylene mesh.Posterior vaginal wall repair may be better than transanal repair in the management of rectocele in terms of recurrence of prolapse. The evidence is not supportive of any grafts at the time of posterior vaginal repair. Adequately powered randomised, controlled clinical trials with blinding of assessors are urgently needed on a wide variety of issues, and they particularly need to include women's perceptions of prolapse symptoms. Following the withdrawal of some commercial transvaginal mesh kits from the market, the generalisability of the findings, especially relating to anterior compartment transvaginal mesh, should be interpreted with caution.
Topics: Cystocele; Female; Gynecologic Surgical Procedures; Humans; Pelvic Organ Prolapse; Randomized Controlled Trials as Topic; Rectal Prolapse; Surgical Mesh; Suture Techniques; Urinary Incontinence; Uterine Prolapse
PubMed: 23633316
DOI: 10.1002/14651858.CD004014.pub5 -
Hernia : the Journal of Hernias and... Oct 2012Recurrence and pain are the two most important outcomes after inguinal hernia surgery. The concept of lightweight or partially absorbable macroporous meshes was... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Recurrence and pain are the two most important outcomes after inguinal hernia surgery. The concept of lightweight or partially absorbable macroporous meshes was developed under the assumption that the observed pain rate could be decreased without increasing the number of recurrences. Few randomized trials were published to analyze their clinical value, and some concern was raised because of an increased risk of recurrence. A systematic review and a meta-analysis of RCTs were carried out to determine whether the use of lightweight meshes influenced the pain and recurrence rate after Lichtenstein hernioplasty.
METHODS
To assess the value of the lightweight mesh, an extensive literature search was performed. The random-effect meta-analysis model was used to correct for clinical diversity and methodological variations between studies. Recurrence rate, aspects of chronic pain and foreign body feeling at 6-60 months postoperatively were assessed.
RESULTS
Eight prospective RCTs of good quality were identified. Analysis demonstrated no significant difference regarding recurrence (OR, 1.11; 95 % CI, 0.57-2.14; p = 0.77). No significant difference was observed concerning severe pain (OR, 0.99; 95 % CI, 0.48-2.02; p = 0.97). Description of any pain resulted in a significant improvement in the lightweight group (OR, 0.65; 95 % CI, 0.50-0.84; p = 0.001). The presence of foreign body feeling was favoring the lightweight group (OR, 0.62; 95 % CI, 0.41-0.94; p = 0.02).
CONCLUSIONS
The use of lightweight mesh did not neither increase the recurrence rate nor reduce the incidence of severe pain. A significant reduction in foreign body feeling and overall pain rate in the postoperative period was recorded. Lightweight meshes could be considered as a material of choice in primary inguinal hernioplasty.
Topics: Chronic Pain; Foreign Bodies; Hernia, Inguinal; Herniorrhaphy; Humans; Pain, Postoperative; Polypropylenes; Randomized Controlled Trials as Topic; Recurrence; Sensation; Surgical Mesh
PubMed: 22824988
DOI: 10.1007/s10029-012-0930-5 -
Hernia : the Journal of Hernias and... Jun 2017Abdominal wall hernia is a common surgical condition, with more than 20 million estimated to be repaired each year. Mesh repair is the standard for most repairs;... (Comparative Study)
Comparative Study Meta-Analysis Review
A systematic review and meta-analysis of the post-operative adverse effects associated with mosquito net mesh in comparison to commercial hernia mesh for inguinal hernia repair in low income countries.
PURPOSE
Abdominal wall hernia is a common surgical condition, with more than 20 million estimated to be repaired each year. Mesh repair is the standard for most repairs; however, the mesh material itself may be a barrier to care, the cost prohibitively high for some populations and healthcare systems. The aim of this systematic review and meta-analysis was to produce a pooled comparison between the adverse event rate associated with mosquito net mesh and commercial hernia mesh.
METHODS
A systematic review was carried out in accordance with PRISMA guidelines. PubMed, Ovid Embase/Medline, SCOPUS, Web of Science and the Cochrane library were searched. In addition, the ISRCTN register, ClinicalTrials.gov, ICTR Platform and EU Clinical Trials Register were searched.
RESULTS
Five randomised controlled trials (RCTs) were identified. The RCTs were deemed to have similar sample populations after inspection of their sample parameters. Therefore, the adverse effects were compared individually (reoccurrence, haematoma, seroma, infection, and serous discharge) and pooled. A total of 313 mosquito net meshes were included in the study, there was no significant difference between the intervention and control groups for pooled adverse effects or individually.
CONCLUSIONS
There is not a significant difference between the commercial mesh group and the mosquito net mesh group for pooled [odds ratio 0.93 (0.63, 1.35)] and individual adverse event rates. However, the 95% confidence intervals of these results are still wide. To reduce this uncertainty sample sizes must increase in future studies.
Topics: Hernia, Inguinal; Humans; Mosquito Nets; Polypropylenes; Prostheses and Implants; Prosthesis Implantation; Surgical Mesh
PubMed: 28409276
DOI: 10.1007/s10029-017-1608-9 -
Environmental Pollution (Barking, Essex... Dec 2022Coastal lagoons are transitional environments between continental and marine aquatic systems. Globally, coastal lagoons are of great ecological and socioeconomic... (Review)
Review
Coastal lagoons are transitional environments between continental and marine aquatic systems. Globally, coastal lagoons are of great ecological and socioeconomic importance as providers of valuable ecosystem services. However, these fragile environments are subject to several human pressures, including pollution by microplastics (MPs). The aim of this review was to identify and summarize advances in MP pollution research in coastal lagoons across the world. We consider peer-reviewed publications on this topic published in English and Spanish between 2000 and April 21, 2022, available in Scopus and Google Scholar. We found 57 publications with data on MP abundances and their characteristics in 50 coastal lagoons from around the world, 58% of which have some environmental protection status. The number of publications on this type of pollution in lagoons has increased significantly since 2019. Methodological differences amongst studies of MPs in coastal lagoons were nevertheless a limiting factor for wide-ranging comparisons. Most studies (77%) were conducted in single environmental compartments, and integration was limited, hampering current understanding of MP dynamics in such lagoons. MPs were more abundant in lagoons with highly populated shores and watersheds, which support intensive human activities. On the contrary, lagoons in natural protected areas had lower abundances of MPs, mostly in sediments and organisms. Fiber/filament and fragment shapes, and polyethylene, polyester, and polypropylene polymers were predominant. MPs had accumulated in certain areas of coastal lagoons, or had been exported to the sea, depending on the influence of seasonal weather, hydrodynamics, anthropogenic pressures, and typology of MPs. It is advised that future research on MP pollution in coastal lagoons should focus on methodological aspects, assessment/monitoring of pollution itself, MP dynamics and impacts, and prevention measures as part of a sound environmental management.
Topics: Humans; Microplastics; Plastics; Geologic Sediments; Ecosystem; Water; Environmental Monitoring; Water Pollutants, Chemical; Polyethylene
PubMed: 36240966
DOI: 10.1016/j.envpol.2022.120366 -
Hernia : the Journal of Hernias and... Aug 2013Incisional hernia is a common long-term complication after laparotomy. This study investigated whether prophylactic mesh reinforcement of laparotomy reduced the rate of... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Incisional hernia is a common long-term complication after laparotomy. This study investigated whether prophylactic mesh reinforcement of laparotomy reduced the rate of incisional hernia, with emphasis on trial design and quality.
METHODS
A systematic review of published literature was performed for studies comparing incisional hernia presence following conventional closure or prophylactic mesh reinforcement. Studies were assessed using the Cochrane Risk of Bias Tool, the Jadad score and the Newcastle Ottawa Scale (NOS). The primary endpoint was incisional hernia, assessed by meta-analysis.
RESULTS
Seven studies [four randomised controlled trials (RCTs) and three prospective trials] included 588 patients; 262 received mesh reinforcement. All studies included elective patients at high risk of incisional hernia. Six incorporated a polypropylene mesh and one a biologic mesh. Four studies were judged high quality by NOS and two of four RCTs were at low risk of bias, although overall outcome assessment from all studies was either poor or mediocre. Mesh significantly reduced the rate of incisional hernia [odds ratio (OR) 0.15, p < 0.001]; the same effect was seen in RCTs only (OR 0.17, p < 0.001). A borderline increase of seroma seen with a fixed effect model (OR 1.82, p = 0.050) was not seen with a random effect model (OR 1.86, p = 0.210, I (2) = 45 %).
CONCLUSION
Mesh reinforcement of laparotomy significantly reduced the rate of incisional hernia in high-risk patients. However, poor assessment of secondary outcomes limits applicability; routine placement in all patients cannot yet be recommended. More evidence regarding the rates of adverse events, cost-benefits and quality of life are needed.
Topics: Hernia, Ventral; Humans; Laparotomy; Surgical Mesh
PubMed: 23712289
DOI: 10.1007/s10029-013-1119-2 -
Medical Devices (Auckland, N.Z.) 2019Controversy exists regarding the outcomes following ventral hernia repair with polypropylene (PP) or polyester (PET) mesh. Monofilament PP less frequently requires...
PURPOSE
Controversy exists regarding the outcomes following ventral hernia repair with polypropylene (PP) or polyester (PET) mesh. Monofilament PP less frequently requires extraction in the setting of contamination compared to multifilament PET mesh. The purpose of this systematic review and meta-analysis was to analyze the clinical outcomes of ventral hernia repair with PP and PET mesh.
PATIENTS AND METHODS
A comprehensive literature search was performed using the Ovid search platform. Criteria included ventral hernia repair publications using either PP or PET mesh with a minimum follow-up duration of one year. Included studies were subject to data extraction including mesh position, weight, recurrence rates, infection, and complications. Random effect meta-analysis was run to provide pooled event rate and 95% CI.
RESULTS
Ninety-seven studies including a total of 10,022 patients were included in the final analysis. Hernia recurrence rates are similar (4.8%, 95% CI [3.5-6.5] vs 4.7%, 95% CI [3.7-6.0]) as well as mesh infection rates (3.5%, 95% CI [2.5-4.9] vs 5.0%, 95% CI [3.9-6.3]) between PET and PP, respectively. Mesh infections occurred less frequently in laparoscopic repair compared to open (1.6%, 95% CI [0.9-2.6] vs 5.2%, 95% CI [4.3-6.3]).
CONCLUSION
This study suggests that mesh material does not affect recurrence or infection in ventral hernia repair and that surgery can be safely performed with both PP and PET mesh. A laparoscopic approach is associated with a decreased infection rate compared to open repair independent of mesh type.
PubMed: 31572024
DOI: 10.2147/MDER.S198988 -
PloS One 2015A systematic review and meta-analysis was performed in randomized controlled trials (RCTs) to compare porcine small intestinal submucosa (SIS) with polypropylene in open... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
A systematic review and meta-analysis was performed in randomized controlled trials (RCTs) to compare porcine small intestinal submucosa (SIS) with polypropylene in open inguinal hernia repair.
METHOD
Electronic databases MEDLINE, Embase, and the Cochrane Library were used to compare patient outcomes for the two groups via meta-analysis.
RESULT
A total of 3 randomized controlled trials encompassing 200 patients were included in the meta-analysis. There was no significant difference in recurrence (P = 0.16), hematomas (P = 0.06), postoperative pain within 30 days (P = 0.45), or postoperative pain after 1 year (P = 0.12) between the 2 groups. The incidence of discomfort was significantly lower (P = 0.0006) in the SIS group. However, the SIS group experienced a significantly higher incidence of seroma (P = 0.03).
CONCLUSIONS
Compared to polypropylene, using SIS in open inguinal hernia repair is associated with a lower incidence of discomfort and a higher incidence of seroma. However, well-designed larger RCT studies with a longer follow-up period are needed to confirm these findings.
Topics: Animals; Databases, Factual; Hematoma; Herniorrhaphy; Humans; Intestine, Small; Odds Ratio; Pain, Postoperative; Polypropylenes; Randomized Controlled Trials as Topic; Recurrence; Seroma; Surgical Mesh; Swine; Treatment Outcome
PubMed: 26252895
DOI: 10.1371/journal.pone.0135073 -
Hernia : the Journal of Hernias and... Apr 2022The surgical implantation of polypropylene (PP) meshes has been linked to the occurrence of systemic autoimmune disorders. We performed a systematic review to determine... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The surgical implantation of polypropylene (PP) meshes has been linked to the occurrence of systemic autoimmune disorders. We performed a systematic review to determine whether PP implants for inguinal, ventral hernia or pelvic floor surgery are associated with the development of systemic autoimmune syndromes.
METHODS
We searched Embase, Medline, Web of Science, Scopus, Cochrane library, clinicaltrialsregister.eu, clinicaltrails.gov and WHO-ICTR platform. Last search was performed on November 24th 2021. All types of studies reporting systemic inflammatory/autoimmune response in patients having a PP implant for either pelvic floor surgery, ventral or inguinal hernia repair were included. Animal studies, case reports and articles without full text were excluded. We intended to perform a meta-analysis. The quality of evidence was assessed with the Newcastle-Ottawa Scale. This study was registered at Prospero (CRD42020220705).
RESULTS
Of 2137 records identified, 4 were eligible. Two retrospective matched cohort studies focused on mesh surgery for vaginal prolapse or inguinal hernia compared to hysterectomy and colonoscopy, respectively. One cohort study compared the incidence of systemic conditions in women having urinary incontinence surgery with and without mesh. These reports had a low risk of bias. A meta-analysis showed no association when comparing systemic disease between mesh and control groups. Calculated risk ratio was 0.9 (95% CI 0.82-0.98). The fourth study was a case series with a high risk of bias, with a sample of 714 patients with systemic disease, 40 of whom had PP mesh implanted.
CONCLUSION
There is no evidence to suggest a causal relationship between being implanted with a PP mesh and the occurrence of autoimmune disorders.
Topics: Animals; Autoimmune Diseases; Cohort Studies; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Polypropylenes; Retrospective Studies; Surgical Mesh; Syndrome
PubMed: 35020091
DOI: 10.1007/s10029-021-02553-y -
British Journal of Sports Medicine Jan 2011The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options... (Review)
Review
OBJECTIVES
The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence.
METHODS
Three databases-MEDLINE, Cochrane Database of Systematic Reviews and CINAHL-were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review.
RESULTS
There were no randomised controlled trials identified with this study's search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis.
CONCLUSIONS
The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.
Topics: Adolescent; Adult; Anti-Inflammatory Agents; Athletic Injuries; Female; Humans; Male; Osteitis; Osteomyelitis; Physical Therapy Modalities; Pubic Symphysis; Sports; Young Adult
PubMed: 18812419
DOI: 10.1136/bjsm.2008.050989 -
European Journal of Obstetrics,... May 2023Synthetic materials have been used for the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). During the last 25 years, these... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Synthetic materials have been used for the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). During the last 25 years, these materials were composed mostly of polypropylene (PP), whereas recently the use of polyvinylidene difluoride (PVDF) is of increasing interest due to its characteristics. This study aimed to compare the results after SUI/POP surgery using PVDF versus PP materials by synthesizing the data of relevant existing literature.
STUDY DESIGN
This systematic review and meta-analysis included clinical trials, case-control studies, or cohort studies written in the English language. The search strategy included the electronic databases MEDLINE, EMBASE, and Cochrane, and grey literature (congresses IUGA, EUGA, AUGS, FIGO). All studies have to provide numeric data or odds ratios (OR) of developing a specific outcome in surgeries with PVDF compared with outcomes of other used materials. No restrictions of race or ethnicity were applied, nor chronological restrictions. Exclusion criteria were studies that included patients with cognitive impairment, dementia, stroke, or central nervous system trauma. All studies were screened by two reviewers, initially by title and abstract, and afterward by full text. Disagreements were resolved through mutual consent. All studies were assessed for their quality and bias risk. Data were extracted using a data extraction form formulated in a Microsoft Excel spreadsheet. Our results were divided into studies dealing only with SUI patients, studies dealing only with POP patients, and cumulative analysis of variables expressed in both SUI and POP surgery. The primary outcomes were the rates of post-operative recurrence, mesh erosion, and postoperative pain after surgery with PVDF compared to PP. The secondary outcomes were post-operative sexual dissatisfaction, overall satisfaction rates, hematoma, urinary tract infection, de novo urge incontinence, and reoperation rate.
RESULTS
No differences in the post-operative rates of SUI/POP recurrence, mesh erosion, and pain were found after surgery with PVDF vs surgery with PP. Patients after SUI surgery with PVDF tapes had statistically significant lower rates of de-novo urgency compared to the PP group [OR = 0.38 (0.18, 0.88), p = 0.01]; patients after POP surgery with PVDF materials had statistically significant lower rates of de-novo sexual dysfunction compared to the PP group [OR = 0.12 (0.03, 0.46), p = 0.002].
CONCLUSIONS
This study provided evidence that the use of PVDF in SUI/POP surgeries could be a valid alternative to PP. However our results are limited by uncertainty due to the overall low quality of the existent data. Further research and validation would contribute to better surgical techniques.
Topics: Humans; Pelvic Organ Prolapse; Polyvinyls; Urinary Incontinence, Stress; Cohort Studies; Surgical Mesh
PubMed: 36966589
DOI: 10.1016/j.ejogrb.2023.03.018